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Every year for the past five years, Tucson Democrat Herschella Horton has introduced legislation that would require insurance companies to cover mental-health care at the level they cover treatment of physical maladies.
Every year that the legislation has gotten a hearing, Sue Davis has appeared at the Legislature to testify for the bill. Davis, a career mental-health advocate, doesn't have campaign contributions or fancy lunches or the luxury of camping out full-time at the Capitol. All she has is the story of her son, Todd.
In 1983, at age 20, Todd began showing signs of mental illness. He was a student at the Massachusetts Institute of Technology, and, luckily, his health insurance covered treatment. But when the semester changed and Todd was too sick to go to school, he lost his insurance. He came home to the Valley and his parents, who enrolled him on their HMO.
For three months, the HMO covered medication and monthly visits to a psychiatrist. Then the HMO stopped the coverage.
"We were shocked," Davis recalls. "We had been paying premiums all these years. We thought we were covered."
If Todd had diabetes, he would have been covered, Davis says. But because his illness was mental--his eventual diagnosis was schizo-affected disorder, which includes symptoms of schizophrenia as well as severe depression--he was not.
But the folks from the HMO had an idea, Davis remembers. "They sent us to the public system. They told us to go to the Maricopa Medical Center, to their mental-health annex, because they had an outpatient clinic there."
Todd's been on the public dole ever since, one of the mentally ill people in the state whose care costs taxpayers more than $250 million a year.
Because of advances in medical treatment of mental illness, Todd may soon be well enough to get a job. But if he does, it's possible his health insurance won't cover his medication, which he needs to function. So it may not be cost-effective for Todd to work.
Every year, Todd's story--and the stories of others like him--isn't enough. Super Lobbyists from the insurance companies and the chambers of commerce line up in opposition, and Horton's mental-health parity bill goes down in flames.
Herschella Horton knows why. It's the "M" word. No, not mental. Mandate.
Recently, Horton met with the representatives of the insurance industry and business community who have so vociferously opposed the bill for so long. Their power, she says, is "awesome."
"We all feel for the people who are mentally ill," she recalls one business advocate as saying. "But this is a mandate. And the position of the Arizona Chamber of Commerce is, we don't like mandates."
As if the rest of the hundreds of laws the Legislature passes each year are mere suggestions.
Really, just about every law is a mandate of one kind or another, Horton says, and, she pointed out to the chamber rep, many are laws that the lobbyists representing business and industry support.
Yes, she was told, but those were laws that cut taxes. Not laws that increased insurance-company costs.
It is difficult to estimate the number of Arizonans who do not have adequate mental-health coverage. Federal law requires companies with 51 or more employees to provide equal coverage. And some smaller companies do voluntarily cover mental-health costs, recognizing that doing so can actually save them money. For example, Horton says, depression is the number one reason people miss work.
The chairs of the health committees in both the Senate and House--Sue Grace of Scottsdale and Sue Gerard of Phoenix, respectively--refuse to hear any HMO reform bills or health-care mandates. Last year, the Legislature did pass a bill mandating chiropractic care, but Governor Jane Dee Hull vetoed it.
As of press time, rumors were swirling about who will introduce what this year. Democratic Senator George Cunningham may have an HMO reform package. Republican Representative Debra Brimhall may have a bill that would put HMO issues on the ballot, before the people. And, of course, Herschella Horton will introduce her bill again.
What is the impact of Super Lobbyists in this case? Hard to say. Many elected officials in these parts simply don't like mandates. It's a political philosophy that no amount of lobbying from either side is going to change. But it is true that the insurance and chamber of commerce lobbyists are among the most moneyed, the most ubiquitous, the most powerful of all the lobbyists at the Capitol. And it is true that when she talks about her bill, Horton never mentions her colleagues in the House and Senate. She's up against the Super Lobbyists. If she can convince them, the legislators will follow.
Of Governor Hull, Horton says only, "She's got a lot of [campaign] cash that came in from the HMOs. I'm not sure where that puts her, other than they've got her ear."
Paul Johnson is more direct.
Johnson, the Democrat who challenged Hull in last year's gubernatorial election, spent his entire campaign pointing out how bad health care in Arizona is and how much money the health-care industry contributed to Hull's campaign.
The HMOs "give a lot of money, and what they want out of elected officials is silence and inaction," Johnson says. "They don't need people to come out for them. They just need people not to come out against them. Leave the system the way that it's going. And if you do, their profits will skyrocket, and they'll skyrocket because they're going to take it out of the services they're giving to patients."